Therapy And Calcaneal Apophysitis

Overview

Sever's disease is a pain that occurs in the back of the heel of physically active children at around the time of puberty. Sever's disease occurs due to an inflammation of the growth plate due to excessive pull of the achilles tendon on this growth plate. During puberty the bones quite often grow faster than the muscles and tendons causing the tendons to become tight, this tightness then results in excessive pull on the back of the heel resulting in this painful condition.

Causes

The large calf muscles attach to the heel via a large tendon called the Achilles tendon (See image below). The function of this tendon is to transmit forces produced by the calf muscles to the heel bone. In children, the portion of the heel bone into which the Achilles tendon inserts is separated from the bulk of the heel bone by a growth plate. This growth plate enables bone growth to occur. However, it also represents a site of weakness in the bone. Forcible and repeated contraction of the calf muscles can injure the growth plate. This commonly occurs during a period of rapid growth where the muscles and tendons become tighter as the bones grow. This leads to increased pulling of the calf muscles and Achilles tendon on the heel bone and growth plate.

Symptoms

The typical clinical presentation is an active child (aged 9-10 years) who complains of pain at the posterior heel that is made worse by sports, especially those involving running or jumping. The onset is usually gradual. Often, the pain has been relieved somewhat with rest and consequently has been patiently monitored by the patient, parents, coaches, trainers, and family physicians, in the expectation that it will resolve. When the pain continues to interfere with sports performance and then with daily activities, further consultation is sought. It should be kept in mind that failure to instruct patients and parents that continual pain, significant swelling or redness, and fever are not signs of Sever disease and therefore require further evaluation could result in failure to diagnose a condition with much more serious long-term consequences.

Diagnosis

Sever's disease is diagnosed based on a doctor?s physical examination of the lower leg, ankle, and foot. If the diagnosis is in question, the doctor may order X-rays or an MRI to determine if there are other injuries that may be causing the heel pain.

Non Surgical Treatment

Treatment may consist of one or more of the following, Elevating the heel, Stretching hamstring and calf muscles 2-3 times daily, Using R.I.C.E. (Rest, Ice, Compression, Elevation), Foot orthotics, Medication, Physical therapy, Icing daily (morning), Heating therapy, Open back shoe are best and avoid high heel shoe. The Strickland Protocol has shown a positive response in patients with a mean return to sport in less than 3 weeks.

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